Competency vs. Hours

I have long desired to see the standards for massage therapy education raised in my state and across the nation. Here in North Carolina, the requirement is only 500 hours. That varies in the US, from the unregulated states that have no requirements at all, to the 1000 hours required by New York, Nebraska, and Puerto Rico. The rest fall somewhere in between.

Our neighbors to the north in Canada have a few provinces that are unregulated, but those that are regulated have a much higher hour requirement than the norm here in the US. However, in looking over their documents pertaining to their regulations, I see that it is not really about the number of hours; it is about the basic competencies that they have set forth for an entry-level massage therapist, and I must say that I find it quite impressive. You can read those here.

I imagine that the higher number of hours is merely a by-product of the competencies that are required. It would take a lot more than 500 hours to pack all those competencies in. And I couldn’t find any fault with any of them. It actually bears a lot of similarities to our recent document, the Massage Therapy Body of Knowledge. That’s not a perfect document; it’s just a start on defining what an entry-level therapist should know here. I’ve heard a good many complaints about it. In fairness to the dedicated volunteers who gave of their time and expertise to work on it, they offered a long period for comments from the profession, and I was personally appalled at how few they got. I think they got about 600 or so, and about 50 of them were mine. It was also very telling to me that when our Board sent out a survey to the approximately 40 school owners and program directors recently about raising the standards, only 7 of them bothered to reply. There is a big lack of interest in raising the bar.

The complacency here is staggering, and people just tend to complain after the fact instead of offering input on the front end. It’s the same thing I’ve seen over and over again when it comes to detrimental legislation in our profession; a few dedicated people will contact their legislators before something awful gets passed into law, and the rest will just gripe about it after it happens. That’s another blog, and one that I’ve written several times.

I’ve actually been pushing for our Board to raise educational standards, which like anything a public board is considering gets passed along to a committee for study. It is unfortunate that we could not find any concrete evidence that requiring more hours leads to better test scores. Then again, is that what it’s all about? The ability to pass a test? In our paradigm, yes, it is. We are lacking here in measuring competency in any other way.

I am the author of a popular book on how to pass the exams that are required here, and for over ten years I’ve been teaching a test-prep class as well as tutoring students privately. Let me tell you what I’ve observed. There are some people who can’t pass a test. Does it mean they can’t give a good massage? Not at all. They might be perfectly capable of putting me to sleep on the table or helping my aching back. And on the other hand, we’ve got the people who happen to be good test-takers and who are good at regurgitating information, who couldn’t give a decent massage if their life depended on it. They just don’t have what it takes. The ability to pass a test doesn’t make you competent, in my humble opinion. It just demonstrates that you know a certain amount of information.

When I was reading the Canadian document, I was more than a little envious of it. I kept comparing it to what I learned in massage school, and thinking, “Wow, I wish I had been taught that at the beginning.” In the dozen years since I went to massage school, I have managed to learn most of it through continuing education, self-study, and on-the-job experience. I’m the resourceful type and a go-getter, and I’ve had a modicum of success in spite of not knowing these competencies right out of the gate. I’ve learned a lot of them through the school of hard knocks. There’s no doubt I could have avoided some of those hard knocks if I had known these things at the outset of my career.

As a provider of continuing education, I’ve often been distressed and appalled when people call me up and say something like, “I need 6 hours, do you have any classes that long?” They don’t give a rip if the subject matter interests them or not. I’ve also been informed that “I don’t know why I have to get continuing education, I already know everything I need to know.” They are clueless.

One of my North Carolina colleagues stated on a forum this week that his poll showed that people were very satisfied with the 500 hours, and of course, a lot of people are. Going beyond that requires money and effort, and many people don’t want to spend any more money or effort than they can get by with. I’m personally not interested in just getting by.

Education is never wasted, and hopefully, I still learn something new every day.That’s my goal, anyway. My education didn’t end at 500 hours. It hasn’t reached 3000 yet, but I intend for it to, and I still won’t know everything there is to know.

10 Replies to “Competency vs. Hours”

I completely agree that there should be more training for massage therapists on the front end. I went through a 6 month full time program that was more intense than my bachelor’s degree. It was also a private school & the owner was passionate about our profession. I immediately knew I needed much more training & knowledge so I began a structural integration class 2 months prior to graduating. 2 1/2 years later I have accumulated almost 300 hours of CEs & by March 7th I’ll have over 300. I worked in a physical therapy clinic for 1 1/2 years to gain even more knowledge while maintaining a private practice. Massage therapy must continue to gain credibility as a profession and if schools continue to turn graduates out like cookie cutters it’s going to be a long hard road. There is actually a 12 week course in Knoxville(where I live.) It is an approved program. Where’s the skill development there? One school here didn’t even have a student clinic until this semester. I believe that until more education is required, massage as a profession will suffer. So many of my clients tell me stories about their experiences with some of the large chains & spas. I merely reply by saying it is a massage therapists duty to cleints to keep learning and that’s what set some of us apart. I am also very careful when choosing a CE provider. I call and ask them many questions, sometimes frustrating ones, I’m sure. Sometimes they can’t answer simple foundation questions about the course-but it’s my career. I want the best training I can get, I’m willing to pay for it & I won’t settle. I do hope they raise the standards for CE providers.

Over the past dozen years, I have been busy building massage therapy professional degree programs in two community colleges in NY — one, a small, private Mercy college in a small city, the other a huge, public college in a huge city. In both settings, massage education is a round peg in a square hole. Comparing massage training to that of other allied healthcare professions doesn’t fit because RNs, LPNs, PTAs, OTAs, and other medically oriented associates degree level technicians are trained to work in structured, hierarchical jobs where there is a need to be disciplined to take orders in life or death situations. Training students to work in a private practice requires the development of an entrepreneurial spirit; to work in a spa, hospitality skillsets are needed.

I love the concept of applying competencies rather than hours to our training because it makes these differences explicit. And raising our education standards seems like an obvious necessity in our profession, but I don’t own a lucrative 500-hr school.

Due to the proliferation of 500-hr schools and their franchise massage center counterparts, I’ve recently begun questioning the value of an associates degree to our profession. I had been convinced that we need to develop bachelors and graduate degrees like PTs have, but we don’t have the kinds of jobs that PTs have that demand academic preparation. We can work anywhere, which is one of our joys — a massage chair on the beach, a table on a cabin deck in the woods… MTs are often too busy enjoying their careers to question the state regs or study the MTBOK. I look forward to more discussion about this. (I hope this isn’t full of typos, writing from my phone on the run!)

One of my North Carolina colleagues stated on a forum this week that his poll showed that people were very satisfied with the 500 hours, and of course, a lot of people are.

Well if their education was 500 hours long they won’t know what they are missing out on! You don’t know what you don’t know. The blind spot that you are not aware of is the most dangerous kind of blind spot.

I go back and forth on this one. I used to say that anyone can do a basic massage with 100 hours of training. That isn’t treatment massage! There is a big need for just stress reduction massage I think anyways – well that’s the thing really we don’t really have any research on what is actually needed.

The arguments for licensing are that it protects the public from harm. The other side is what harm exactly? How many are being ‘harmed’ and in what ways. If there was a significant harm we wouldn’t have $100 liability insurance. Then there is the “it helps reduce prostitution” – does it really? What are the statistics? As more states have become licensed do prostitutes lose their jobs?

I also think part of the issue is that younger people are now joining the profession and going to massage school without as much life experience as older people. The average age of MT is still around 45 according to stats and I wonder if schools are able to work with younger people who have more needs in learning (or I guess that is my guess on that). I have many young people emailing me through my website asking if they have to take math. If that is why they are choosing a career in massage – well bless us all!

With more younger people going to massage school, I would think that a 2 year program would be helpful to give them more life experience.

I would love to see more research done on all of this before anything new is done. What about states like Minnesota (I think it is) where there is a freedom of access law. Has there been more cases of harm or people using massage as a front for prostitution? Or the other unlicensed states – are there more cases of MT hurting clients or doing unethical things?

There are still many claims against massage therapists in licensed states – where are they getting lost? I would love to see clinical supervision be required as a CE.

And what about apprenticeship programs – I still think Keith Grants “Issues in Massage Governance” is important as he does point out why the number of hours has gradually increased- to get more financial aid for students. He also sites apprenticeship programs as a better way to learn. Of course they would have to have standard too.

I agree with the need for additional education. And most of the arguments I hear against it are people who want to “just get by” with putting as little effort and money into their educations as possible. Thank you, Laura, for being willing to state that openly.
And I’ve often brought up the increased Canadian requirements. I just recently moved to my area and now have two clients from Canada who were unable to find other massage therapists in this area who could actually help their pain. They were used to a higher knowledge from their Canadian therapists, and were very disappointed to find nothing more than basic, relaxation massage in this area. Relaxation massage is wonderful and has it’s place, but it’s not the only need for massage out there.
Yes, a nice chair massage on the beach doesn’t require much; but for those of us who want to work in healthcare (and there are a lot of MT’s now getting jobs in Hospitals and other clinical settings), there really should be a more in-depth educational opportunity.

One issue of the additional hours up front is how many people are going to want to go in debt for $20-30 thousand dollars for a profession that on average a person makes $15-30 thousand dollars a year and that is with years of experience. and some research and talking to people who used to be in the profession that 50-70% of people are out of the field in 3 years of graduating from their training.

Who is going to teach those additional classes at lets say a University. The University is going to want the instructor to have a masters degree in some subject, yet I have had the honour of learning great healing skills from people who never stepped in a formal classroom outside of high school. I have had massage therapists who can earn a AS degree in massage therapy tell me that they were never taught to work the glutes.

13 years ago I attended a school that had a 700 hour curriculum. I was on the night-school “track” so it was scheduled to take me 13 months to complete. I chose that schools specifically for the triple-certification that it offered in traditional Swedish, Clinical Sports, and Neuromuscular therapy. There were other local schools with shorter tracks, different curriculum specialties, better locations, more flexible scheduling, but ultimately I wanted the best education I could get for the best price for the best time frame.

In the beginning of my career, that 700 hours was all I needed. It was more than enough to get me started. I was well-versed in therapeutic level work and knowledge. I could have passed any written or practical exam available at the time to US massage therapists. I was also working part-time, from home, while raising two small children. At the time our state only had certification guidelines, but did not have a minimum hours requirement or a license. As the state began to look at licensing requirements, I began to work more and realized it was time for me to seek CE in areas where I needed a refresher or wanted to learn more or felt less than competent compared to my other competencies.

If, to be an MT, I had been required to reach 2000 or 3000 hours or competencies at the outset, I’d have never become an MT. I was working full-time, starting a family, and already had a bachelor’s degree. I’m an excellent therapist. I know a lot more than most I see. I also know there is so much that I do not know.

I think, as we address the issues of education, competency, minimum standards, and the like, we have to address all the issues. I believe that what we lack is not in having across the board standards or requirements, but in our failure to fully define what can/should/is being accomplished at each level of education.

Someone taking a 12-week course, with an interest in body work, and naturally skilled hands might be fully capable of providing relaxation massage, but it’s clear they wouldn’t have the knowledge base or skill level of someone who’s had 500-750-1000 hours of education. Likewise, someone having taken the equivalent of Neuromuscular I isn’t going to have the same degree of competency in providing Neuromuscular therapy as someone who’s taken Neuromuscular I-V.

When I was training for my Reiki mastery, it was reiterated to me at every step what the different levels meant for how we could practice. Level I meant you could work on yourself, your closest friends, family, and pets, but that you could not charge money, you could not hang out a shingle and advertise. Level II meant you could offer your services to others in exchange for payment. Level III meant you could teach others the art of Reiki. While many versions of this exist and I’m sure some would argue that they were taught differently, I’ve always been impressed and grateful that these delineations were set forth for me.

I believe for Massage Therapy we need to define better what should be acceptable at each level of work – acceptable in terms of education, in terms of experience, and in terms of standard competency requirements. I don’t think it’d be wise of us to raise the standards at the outset so much that we price people out of the field both in money and time. I love that I work in a field where I can grow at my own pace: sometimes that’s 6 hours worth of growth and sometimes that’s 100 hours worth of growth.

We can’t make people care about this if they don’t already – that’s true of every profession (not every doctor is the best doctor, not every lawyer the best lawyer), but we can clarify expectations at various levels and allow practitioners to raise to the level of their own capabilities and willingness and allow clients to choose what they want and expect from each.